The nurse is caring for a macrosomic newborn of a woman diagnosed with gestational diabetes immediately after birth. What assessment findings can the nurse anticipate? (Select All that Apply.)

Choice A rationale Macrosomic newborns of diabetic mothers frequently experience hyperbilirubinemia (jaundice) due to several factors, including polycythemia (increased red blood cell mass secondary to chronic intrauterine hypoxia) and the large size often leading to birth trauma (e.g., bruising, cephalohematoma), both of which increase the erythrocyte breakdown, overloading the conjugation capacity of the immature liver. Normal bilirubin is less than 5.2 mg/dL. Choice B rationale Hypocalcemia (serum calcium level <7.0 mg/dL) is common in these newborns, usually appearing in the first 24-48 hours of life. The proposed mechanism involves functional hypoparathyroidism in the infant, potentially due to rapid drops in maternal calcium or magnesium levels postpartum, and birth stress, leading to a temporary inability to maintain calcium homeostasis. Choice C rationale Macrosomia is defined by excessive growth, typically a weight greater than 4000 g (approx 8 lbs 13 oz) at term, and is characterized by increased subcutaneous fat, particularly over the shoulders and trunk, due to fetal hyperinsulinemia. Insulin acts as a primary growth factor, promoting the synthesis and storage of fat and glycogen, so decreased fat is an incorrect finding. Choice D rationale Macrosomia is generally defined as a birth weight greater than the 90th percentile for gestational age, or an absolute weight of 4000 grams (8 lbs 13 oz) or more, regardless of gestational age. A weight of 9 pounds (4082 grams) or more is a clear indicator of this condition, often resulting from the hyperinsulinemic state caused by sustained maternal hyperglycemia.